Ankle

The ankle is the most commonly injured joint in athletics

The bony structure of the ankle is very strong

With moderate ligament support And poor muscular support

Bones

Tibia (Medial Malleolus) Fibula (Lateral Malleolus) Calcaneus Talus

Lateral Ligaments

Anterior talofibular Calcaneofibular Posterior talofibular

Medial ligaments

Deltoid Ligaments

Ankle re-injury

Tight Achilles tendon is the major cause of recurrent ankle sprains

Prevention

Stretch musculature of the ankle Resistive strengthening of the musculature Inversion Eversion Plantar flexion dorsiflexion

Mechanism of injury

Inversion eversion

Inversion

Stepping in a hole Stepping on another persons foot Stepping on a rock

Anterior talofibular ligament injured

Eversion ankle sprain

Stepping in a hole Stepping on another persons foot Stepping on a rock

Deltoid ligament injured

1st degree (Mild) ankle sprain

Ligaments are stretched Minor discomfort Point tenderness Mild swelling

2nd Degree (Moderate) Ankle Sprain

Ligaments are stretched and/or Partially torn

Moderate pain Point tenderness Some loss of function Slight abnormal movement at the joint

3rd degree (Severe) Ankle sprain

Ligaments are completely torn Extreme pain Total loss of function Point tenderness Rapid swelling

Evaluation

History

Observation/Inspection

Palpation

Specific testing

Subjective

Objective

Action taken

Plan

History

How did it happen When did it happen Did you hear or feel a pop Where you able to walk on it right away

Observation

Bleeding Swelling Discoloration Deformity Bilaterally comparison

Palpation

Look at bony landmarks Soft tissue Bilateral comparison

Fracture

Direct pain Indirect pain Deformity Grating sounds (Crepitation) Testing

Compression Percussion Tuning fork

Functional Testing

Passive ROM Active ROM Resistive ROM

Sports Specific Testing

Hop 10 times on injured limb Walk Run straight Run circles Figure 8’s Zig zag 90 degree cutting

Treatment

Rest Ice 20 minutes every two hours Compression with horseshoe/elastic wrap Elevation Avoid heat in any form Remove elastic wrap before bedtime Follow this treatment for 1-72 hours

Once the bleeding has stopped

Apply heat before activity and ice after to… Remove waste product from injured area Promote healing Increase ROM

Rehabilitation

Recovery is: Absence of pain Full ROM Full Strength Full flexibility

Range of motion

Working toward complete pain free ROM Flex & Plantarflex foot as far as possible Invert and evert foot as far as possible Circular motion clockwise and counter Write capital letters with the toes Achilles tendon stretch

Resistive Exercises

Walk on hells and toes (toes up, out, & in) Pick up marbles with toes Towel toe curl Isometric inversion and eversion with chair

legs Calf (heel) raises with feet straight in & out

Resistive Exercises continued

Closed chain kinetic exercises BOSU ball exercises Trapoline exercises Dinodisc exercises Voo doo board exercises

Return to activity

Do all of the following at 50,75, & 100% Hop 10 times on injured limb Walk Run straight Run circles Figure 8’s Zig zag 90 degree cutting

Heel Bruise

Heel and arch receives, absorbs and transfers most of the impact

Heel Bruise is one of the most disabling contusions

Heel bruise Treatment

Heel lift (poss. donut hole) Cold application before and ice after

Activity

Plantar Fasciitis

Wide inelastic ligament that supports the arch of the foot

Cause of plantar Fasciitis

Overuse Overweight Tight Achilles Improper shoe support Running on hard surface

Signs of plantar fasciitis

Pain and tenderness on the bottom of the foot near the heal

Treatment plantar fasciitis

RICE Tape support (slipper)

Heel Spur

Bony growth on Calcaneus Cause

Flat feet

Turf toe

Sprain of the great toe (MP joint) The great toe is important in movement, balance

and speed Cause

Foot sliding back on a slippery surface Hyperextension of the big toe

Treatment RICE

Taping Turf toe taping

Taping Tests

Slipper Turf toe Achilles